ONE YEAR DISEASE FREE SURVIVAL IN ACUTE MYELOID LEUKEMIA PATIENTS AFTER INDUCTION REMISSION

Authors

  • Mehwish Roshan Shaikh Department of Medical Oncology, Jinnah Postgraduate Medical Centre, Karachi-Pakistan
  • Ghulam Haider Department of Medical Oncology, Jinnah Postgraduate Medical Centre, Karachi-Pakistan
  • Aisha Shahid Department of Medical Oncology, Jinnah Postgraduate Medical Centre, Karachi-Pakistan
  • Raja Rahool Department of Medical Oncology, Jinnah Postgraduate Medical Centre, Karachi-Pakistan
  • Shumyla Beg Department of Medical Oncology, Jinnah Postgraduate Medical Centre, Karachi-Pakistan
  • Paras Memon Department of Medical Oncology, Jinnah Postgraduate Medical Centre, Karachi-Pakistan
  • Bhunisha Department of Medical Oncology, Jinnah Postgraduate Medical Centre, Karachi-Pakistan
  • Maryum Nouman Department of Medical Oncology, Jinnah Postgraduate Medical Centre, Karachi-Pakistan

Abstract

Background: Diagnostic karyotyping analysis is routinely used in acute myeloid leukaemia (AML) clinics. Categorization of patients into risk stratified groups (favourable, intermediate and unfavourable) according to cytogenetic findings can serve as a valuable independent prognostic factor. The aim of this study was to assess the one-year disease free survival rate in AML patients after induction remission presenting at tertiary care hospital of Karachi. Methods: It was a longitudinal study conducted at the department of Medical oncology of Jinnah Postgraduate Medical Center, Karachi from Jun 2017–Jan 2019. Ninety-three diagnosed cases of AML of age 15-55 years of either gender were included in the study. All patients received the first cycle of “3+7” regime for induction chemotherapy. This includes Daunorubicin 45 mg/m2 on days 1 to 3 and Cytarabine in a dose of 100 mg/m2 from day 1–7. Marrow response was assessed on the 21th day of induction therapy. If the bone marrow includes lesser than five percent blast cells then it was labelled as complete remission (CR). The patients who achieved CR and normal haematopoiesis were eligible to receive 4 cycles of consolidation therapy with cytarabine 3 mg/m2 every 12 hour on days 1, 3 and 5. Consolidation cycles were monthly administered. All the patients who achieved CR were follow up for the duration of one year for disease free survival. On follow up monthly visits, outcomes were assessed using CBC report and physical examination. Results: After 1 year, out of 72 AML patients, 19 patients remained in complete remission, 5 patients lost to follow up, 3 relapses, 19 showed persistent disease & 28 died during consolidation. According to cytogenetic status, CR was achieved in 6 patients (50%) with favourable cytogenetic, 14 patients (28%) with intermediate cytogenetic and 2 patients (20%) with unfavourable cytogenetic status. The highest median survival time was observed in patients with favourable cytogenetic status as 5.23 months. However, there was no significant difference was observed in survival time with respect to cytogenetic status. Conclusion: The “3+7” regime of Daunorubicin & Cytarabine is effective in inducing induction remission and increases 1 year survival, however chemotherapy related morality rate was high in unfavourable cytogenetic group

References

Kumar CC. Genetic abnormalities and challenges in the treatment of acute myeloid leukemia. Genes Cancer 2011;2(2):95–107.

Lagunas-Rangel FA, Chávez-Valencia V, Gómez-Guijosa M, Cortes-Penagos C. Acute Myeloid Leukemia-Genetic Alterations and Their Clinical Prognosis. Int J Hematol Oncol Stem Cell Res 2017;11(4):328–39.

El Rassi F, Arellano M. Update on optimal management of acute myeloid leukemia. Clin Med Insights Oncol 2013;7:181–97.

ACS. Key Statistics for Acute Myeloid Leukemia (AML) 2019. [Internet]. [cited 2019 Jun 7]. Available from: https://www.cancer.org/cancer/acute-myeloid-leukemia/about/key-statistics.html

Nasim NNN, Malik K, Mobeen NAMS, Awan S, Maz N. Investigation on the prevalence of Leukaemia at a tertiary care hospital, Lahore. Biomedica 2013;29(1):19–22.

Zaki S, Burney IA, Khurshid M. Acute myeloid leukemia in children in Pakistan: an audit. J Pak Med Assoc 2002;52(6):247–9.

ACS. Treatment Response Rates for Acute Myeloid Leukemia (AML): American Cancer Society; 2018 [Internet]. [cited 2019 Jun 7]. Available from: https://www.cancer.org/cancer/acute-myeloid-leukemia/treating/response-rates.html

Rajeev PC, Deepa A. Clinico-Epidemiological Aspects of Acute Myeloid Leukemia-An Observational Study. Ann Int Med Den Res 2018;4(2):MC01–7.

Estey EH. Acute myeloid leukemia: 2019 update on risk-stratification and management. Am J Hematol 2018;93(10):1267–91.

NCCN. Acute Myeloid Leukemia National Comprehensive Cancer Network. [Internet]. [cited 2019 July 10]. Available from: www.nccn.org

Seval GC, Ozcan M. Treatment of Acute Myeloid Leukemia in Adolescent and Young Adult Patients. J Clin Med 2015;4(3):441–59.

Zeijlemaker W, Schuurhuis G. Minimal Residual Disease and Leukemic Stem Cells in Acute Myeloid Leukemia. Leuk Guenova M Ed IntechOpen Lond UK 2013;15:195–226.

De Kouchkovsky I, Abdul-Hay M. 'Acute myeloid leukemia: a comprehensive review and 2016 update'. Blood Cancer J 2016;6(7):e441.

Kurosawa S, Yamaguchi T, Miyawaki S, Uchida N, Sakura T, Kanamori H, et al. Prognostic factors and outcomes of adult patients with acute myeloid leukemia after first relapse. Haematologica 2010;95(11):1857–64.

Kakepoto GN, Burney IA, Zaki S, Adil SN, Khurshid M. Long-term outcomes of acute myeloid leukemia in adults in Pakistan. J Pak Med Assoc 2002;52(10):482–6.

ACS. Leukemia - Acute Myeloid - AML: Statistics Cancer. Net Editorial Board; 2019 [Internet]. [cited 2019 Jan 22]. Available from: https://www.cancer.net/cancer-types/leukemia-acute-myeloid-aml/statistics

Vignetti M, Orsini E, Petti MC, Moleti ML, Andrizzi C, Pinto RM, et al. Probability of long-term disease-free survival for acute myeloid leukemia patients after first relapse: A single-centre experience. Ann Oncol 1996;7(9):933–8.

Arber DA, Orazi A, Hasserjian R, Thiele J, Borowitz MJ, Le Beau MM, et al. The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood 2016;127(20):2391–405.

Othus M, van Putten W, Lowenberg B, Petersdorf SH, Nand S, Erba H, et al. Relationship between event-free survival and overall survival in acute myeloid leukemia: a report from SWOG, HOVON/SAKK, and MRC/NCRI. Haematologica 2016;101(7):e284–6.

Hu J CY, Zheng X, Zheng Z, Yang T, Tingbo LI. Comparison of Outcome and Prognosis of 248 Elderly Patients with Acute Myeloid Leukemia Treated with Standard-Dose or Low-Intensity Induction Therapy. Blood 2015;126(23):2540.

Rowe JM, Kim HT, Cassileth PA, Lazarus HM, Litzow MR, Wiernik PH, et al. Adult patients with acute myeloid leukemia who achieve complete remission after 1 or 2 cycles of induction have a similar prognosis: a report on 1980 patients registered to 6 studies conducted by the Eastern Cooperative Oncology Group. Cancer 2010;116(21):5012–21.

Gerstung MPE, Martincorena I, Bullinger L, Gaidzik VI, Paschka P, Heuser M, et al. Precision oncology for acute myeloid leukemia using a knowledge bank approach. Nat Genet 2017;49(3):332–40.

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Published

2021-06-30

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